НОВОЕ В ЛЕЧЕНИИ ПЕРЕЛОМОВ НАДКОЛЕННИКА

In the literature there is a gap of publications about patella fractures management which is due to the absence of serious attention to the injuries of this largest sesamoid bone. In addition, in the world literature there is a lack of monographs and toolkits for the treatment of patients with these injuries, furthermore, in textbooks and traumatology manuals there are only a few template recommendations to the tactics of treating patients with this trauma. Meanwhile, patella fractures represent approximately 0.5-1.5% of all fractures, delayed union, formation of a false joint, and the emergence of patellofemoral arthrosis after these fractures is not uncommon. In the scientific literature on traumatology there is no unified, all-recognized classification of these fractures, which hinders the development of a single algorithm for the treatment of patients with patellar fractures. There are no contradictory views to the treatment of patella fractures without displacement; however, in relation to the treatment of patients with complex patella fractures, there are divergent views between the fracture fragments preservation to partial or even total patellectomy. In connection with the foregoing, We considered the issue of treating patients with patella fractures topical. Based on a thorough analysis of treatment results of 113 patients we provided a working classification based on the number of patellar fracture fragments (two-fragmentary, three-fragmentary, four-fragmentary, multi-fragmentary, upper and lower pole fractures). Based on this classification, traditional, modified and new methods of treating patients with patellar fractures were used. This is described in more detail in the forthcoming article.В мировой литературе чрезвычайно мало публикаций по переломам надколенника, что связано с отсутствием серьезного внимания к повреждениям этой самой большой сесамовидной кости человека. Кроме того, в мировой литературе имеются лишь единичные монографии и учебные методические пособия по лечению пациентов с этими повреждениями, а в учебниках и руководствах по травматологии имеются лишь несколько шаблонных рекомендаций по тактике лечения пациентов с данной травмой. Между тем переломы надколенника составляют от 0,5-1,5% из всех переломов костей скелета, замедленное сращение или образование ложного сустава и развитие пателлофеморального артроза после этих переломов не являются редкостью. В научной литературе по травматологии нет единой, всеми признанной классификации этих переломов, что препятствует разработке единого алгоритма по лечению пациентов с переломами надколенника. О лечении переломов надколенника без смещения нет противоречивых взглядов, однако по отношению к лечению пациентов со сложными переломами надколенника имеются противоположные мнения от сохранения отломков до частичного или даже полного удаления надколенника (пателлектомии). В связи с вышеизложенным мы сочли вопрос лечения пациентов с переломами надколенника актуальным, и на основании тщательного анализа результатов лечения 113 пациентов разработали рабочую классификацию, основанную на количестве фрагментов перелома надколенника (двухфрагментарные, трехфрагментарные, четырехфрагментарные, многооскольчатые, а также переломы верхнего и нижнего полюсов). На основании этой классификации были применены традиционные, усовершенствованные и новые методики лечения пациентов с переломами надколенника

CHILD HEADACHE: MODERN CLASSIFICATION, CLINICAL DETAILS, TREATMENT ISSUES

The article is devoted to classification, diagnostics and treatment of headaches. It describes positive properties of ibuprofen which is recommended for relieving pain for children as young as 3 months old.Key words: children, headache, classification, diagnostics, treatment.</strong

CHILD HEADACHE: MODERN CLASSIFICATION, CLINICAL DETAILS, TREATMENT ISSUES

The article is devoted to classification, diagnostics and treatment of headaches. It describes positive properties of ibuprofen which is recommended for relieving pain for children as young as 3 months old.Key words: children, headache, classification, diagnostics, treatment

Hemophagocytic lymphohistiocytosis associated with herpes infection

G.S. Karpovich1,2, A.E. Shestakov1, E.I. Krasnova1 1Novosibirsk State Medical University, Novosibirsk, Russian Federation 2Children’s City Clinical Hospital No. 3, Novosibirsk, Russian Federation Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal disease affecting multiple organs and systems which is induced by the dysregulation of the immune response due to mutations in the genes controlling cytolytic function. This leads to the abnormal activation of cytotoxic T cells, monocytes/macrophages, and the development of a systemic inflammatory response. In some cases, patients with HLH require emergency therapy in intensive care or resuscitation units. The article highlights the issues of HLH etiopathogenesis, its clinical, diagnostic and treatment aspects. As association was found between secondary HLH and infections caused by the herpesvirus group. The diagnosis of this condition is challenging because of its nonspecific symptoms, especially in early stages of the disease, which leads to an uncertain prognosis. The authors present case reports of two pediatric patients with secondary HLH induced by herpesvirus mixed infection. The clinical cases were characterized by the manifestations of acute dual infection with Epstein-Barr virus and cytomegalovirus, and HLH symptoms that were consistent with the diagnostic criteria of the disease described in the article. For selecting an adequate therapy, it is necessary to conduct high-quality comprehensive diagnostic testing with the involvement of hematologists, rheumatologists. and oncologists. Keywords: hemophagocytic lymphohistiocytosis, infectious diseases, herpes virus, Epstein-Barr virus, cytomegalovirus, hematology, mixed infection. For citation: Karpovich G.S., Shestakov A.E., Krasnova E.I. Hemophagocytic lymphohistiocytosis associated with herpes infection. Russian Journal of Woman and Child Health. 2022;5(3):262–269 (in Russ.). DOI: 10.32364/2618-8430-2022-5-3-262-269. </p

Staphylococcal toxic shock syndrome in a child. Case report

G.S. Karpovich1,2, I.V. Kuimova1, E.I. Krasnova1, D.S. Maramygin2, A.Yu. Enikeev2 1Novosibirsk State Medical University, Novosibirsk, Russian Federation 2Children’s City Clinical Hospital No. 3, Novosibirsk, Russian Federation Toxic shock syndrome (TSS) is a complex of symptoms that includes fever, exanthem, multiple organ dysfunction syndrome, and hypotension. The most common causative agents are S. aureus and group A Streptococcus. TSS is characterized by severe course and high mortality in the lack of specific complex treatment. This article addresses a case report of staphylococcal TSS in a 5-year-old girl. The primary focus of infection (infected right leg wound) and breakthrough factors (the lack of adequate wound care) resulted in the dissemination of causative agent and TSS development. Despite disease severity, early complex etiological (antibiotics) and pathogenically-oriented (infusions, corticosteroids) treatment improved the patient’s condition and promoted recovery. This case report illustrating the classic presentations of staphylococcal TSS in children is helpful for pediatricians in terms of awareness of this pathological condition. Keywords: infectious diseases, staphylococcus aureus, toxic shock syndrome, cytokine storm, multiple organ failure syndrome, pediatrics. For citation: Karpovich G.S., Kuimova I.V., Krasnova E.I. et al. Staphylococcal toxic shock syndrome in a child. Case report. Russian Journal of Woman and Child Health. 2021;4(3):302–307 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-302-307. </p

Гемолитико-уремический синдром. Возможная этиологическая роль инфекции, вызванной Campylobacter

Hemolytic uremic syndrome (HUS), one of the forms of thrombotic microangiopathy, is a severe emergency with non-immune (Coombs negative) anemia, thrombocytopenia and acute renal injury. HUS is heterogeneous, and its most common form, the typical HUS, is associated with Shiga toxin (Stx) producing bacteria, such as Escherichia coli, Shigella dysenteriae, and Citrobacter freundii. Less frequent is HUS, caused by a neuraminidase producing streptococcus (pneumococcal HUS). The most uncommon form is the atypical HUS, which is a genetic orphan disease associated with an abnormality in the regulatory protein of the complement system. HUS has a fairly high mortality rate, amounting to 10–15% on average. The long-term outcomes of HUS depend on its type, as well as on the degree of the primary body tissue damage. According to the data from Novosibirsk Children's Municipal Clinical Hospital No 3 from 1991, 44 cases of HUS in children have been identified. Complete recovery, without any residual abnormalities, was registered in 25 children (56.8% of the cases). Nine children (20.5%) developed chronic kidney disease and 10 (22.7%) of all HUS cases were fatal. Early diagnosis, as well as the identification of pathogenetic mechanisms, is the basis for adequate therapy and outcome prediction. Campylobacter may be one of the causative agents of HUS. Despite new cases of Campylobacter-associated HUS being registered in the world, the very possibility of HUS induction by this pathogen and its pathophysiology are currently unclear. There is no convincing evidence for both Stx and the neuraminidase-related mechanism of HUS in Campylobacter infections. Given the high incidence of autoimmune disorders like Guillain-Barre syndrome and reactive arthritis in Campylobacter infections, it is currently impossible to exclude an autoimmune mechanism of HUS in these diseases. Thus, the role of Campylobacter, as a new potential bacterial agent of HUS, as well as the pathogenesis of such conditions in Campylobacter infections, requires further study.Одна из форм тромботической микроангиопатии гемолитико-уремический синдром (ГУС) представляет собой тяжелую, ургентную патологию, характеризующуюся развитием неиммунной (Кумбс-отрицательной) анемии, тромбоцитопении и острого почечного повреждения. Для ГУС свойственна гетерогенность форм. Наиболее частая форма – типичный ГУС – связана с бактериями, продуцирующими Шига-токсин (Stx), Escherichia coli, Shigella dysenteriae, Citrobacter freundii. Реже встречается ГУС, вызванный стрептококком, продуцирующим нейраминидазу, – пневмококковый ГУС. Наиболее редкая форма – атипичный ГУС, генетическое орфанное заболевание, обусловленное нарушением белка регулятора системы комплемента. ГУС отличается достаточно высокой летальностью, достигающей в среднем 10–15%. Долгосрочный прогноз при ГУС зависит от его типа, а также от глубины первоначального повреждения тканей организма. По данным ГБУЗ НСО ДГКБ № 3 (Новосибирск, Россия), начиная с 1991 г. установлено 44  случая развития ГУС у детей. Полное выздоровление, без развития каких-либо нарушений, зафиксировано у 25 (56,8%) детей, развитие хронической болезни почек отмечено у 9 (20,5%) пациентов, летально завершился ГУС в 10 (22,7%) случаях. Ранняя диагностика, а также выявление патогенетических механизмов лежат в основе адекватной терапии и прогнозирования исходов заболевания. Одним из новых этиологических агентов ГУС может быть Campylobacter. Несмотря на то что в мире регистрируются новые случаи ГУС, связанного с Campylobacter, на настоящем этапе не ясны ни сама возможность индукции ГУС данным возбудителем, ни патогенез этого состояния. Нет убедительных доказательств как Stx, так и нейраминидазного механизма развития ГУС при кампилобактерных инфекциях. Учитывая высокую частоту развития при инфекциях, вызванных Campylobacter, таких аутоиммунных патологий, как синдром Гийена – Барре, реактивные артриты, сегодня не представляется возможным исключить аутоиммунный механизм развития ГУС при этих заболеваниях. Таким образом, роль Campylobacter в качестве нового потенциального бактериального агента ГУС, а также патогенез подобных состояний при кампилобактерных инфекциях нуждаются в дальнейшем изучении

Results of surgical treatment of patella fractures

Relevance. There is no single approach in the literature to treat patients with multifragmental patella fractures. After surgical treatment of patients with patella fractures, various complications are observed (needle migration, suppuration, knee joint contractures and patellofemoral arthrosis). Purpose of the study. Improve the results of surgical treatment of patients with patella fractures. Material and methods. We analyzed the long-term results of surgical treatment of 78 patients with fractures of a patella of a different nature in the period from 2017-2018. To evaluate the results, we used the KOOS scale (The Knee Injury and Osteoarthritis Outcome Score) and performed a clinical examination and X-ray examination of patients, we also took into account patients' opinions about the result of treatment. The average follow-up for patients was one year and 10 months. Results and conclusions. The best treatment results were observed in patients with transverse fractures after osteosynthesis with two knitting needles and a tightening wire loop. Patellectomy followed by fixation with a blocking wire loop should be avoided for all types of patella fractures, including fractures of the lower pole and multi-fragmented patella fractures. © 2020, Advanced Scientific Research. All rights reserved

Перампанел в дополнительной терапии фокальных и первично-генерализованных тонико-клонических приступов у детей 4–12 лет: клинические данные, опыт применения и практические рекомендации

On March 18, 2021, an online council of experts in the field of epilepsy treatment was held, dedicated to the use of perampanel in the additional therapy of focal seizures (FS) and primary generalized tonic-clonic seizures (PGTCS) in children 4–12 years old. During the event, the features of the use of perampanel in this group of patients were discussed, considering the specifics of everyday clinical practice, current possibilities of PGTCS and FS therapy in children, its goals, as well as unsolved problems in the treatment of pediatric patients with PGTCS and FS. Particular attention was paid to the role of perampanel in the treatment of PGTCS and FS in children and its effectiveness in specific types of focal seizures. © 2021 IRBIS LLC. All rights reserved